Bottom Line:
Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea.Direct visualization of the oropharynx revealed a large serpiginous Crohn's disease ulcer.A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn's disease.

Affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta.

ABSTRACTCrohn's disease is a chronic inflammatory disease that can affect any part of the gastrointestinal tract. Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea. This case report describes a 38-year-old woman with Crohn's disease who presented with odynophagia. Direct visualization of the oropharynx revealed a large serpiginous Crohn's disease ulcer. A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn's disease. This manuscript describes the presentation of oropharyngeal Crohn's and reviews previous reports and management options.

Mentions:
Before a biopsy of the lesion could be arranged a drop in the patient’s hemoglobin from 112 g/L to 65 g/L occurred over a 36-hour interval. The patient noted some increase in bowel frequency and bright red blood mixed with the feces. Consultation to the Gastroenterology Service was initiated and a esophago-gastro-duodenoscopy revealed a normal esophagus, stomach, and proximal duodenum with no obvious upper gastrointestinal source to account for the anemia. Colonoscopy demonstrated a normal peri-anal region, rectum, and colon; however, on intubation into the terminal ileum, there were several long, discrete deep ulcers and exudate (Figure 1). Histologic analysis confirmed Crohn’s disease. With this finding of Crohn’s disease in the terminal ileum the esophago-gastro-duodenoscopy was repeated with the aim of carefully inspecting the oropharynx for evidence or oropharyngeal Crohn’s disease. A large (2 × 2 cm), irregular, non-bleeding ulcer was seen in the oropharynx, consistent in size and location with the one identified during direct visualization (Figures 1 and 2). Histologic analysis of the oropharyngeal ulcer confirmed Crohn’s disease. On retrospective questioning the patient recalled a 3-year history of intermittent diarrhea (5–6 bowel movements per day) with intermittent blood in the stool, and associated abdominal cramping and occasional vomiting. The patient’s mother had a history of ulcerative colitis. There was no other family history of inflammatory bowel disease.

Mentions:
Before a biopsy of the lesion could be arranged a drop in the patient’s hemoglobin from 112 g/L to 65 g/L occurred over a 36-hour interval. The patient noted some increase in bowel frequency and bright red blood mixed with the feces. Consultation to the Gastroenterology Service was initiated and a esophago-gastro-duodenoscopy revealed a normal esophagus, stomach, and proximal duodenum with no obvious upper gastrointestinal source to account for the anemia. Colonoscopy demonstrated a normal peri-anal region, rectum, and colon; however, on intubation into the terminal ileum, there were several long, discrete deep ulcers and exudate (Figure 1). Histologic analysis confirmed Crohn’s disease. With this finding of Crohn’s disease in the terminal ileum the esophago-gastro-duodenoscopy was repeated with the aim of carefully inspecting the oropharynx for evidence or oropharyngeal Crohn’s disease. A large (2 × 2 cm), irregular, non-bleeding ulcer was seen in the oropharynx, consistent in size and location with the one identified during direct visualization (Figures 1 and 2). Histologic analysis of the oropharyngeal ulcer confirmed Crohn’s disease. On retrospective questioning the patient recalled a 3-year history of intermittent diarrhea (5–6 bowel movements per day) with intermittent blood in the stool, and associated abdominal cramping and occasional vomiting. The patient’s mother had a history of ulcerative colitis. There was no other family history of inflammatory bowel disease.

Bottom Line:
Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea.Direct visualization of the oropharynx revealed a large serpiginous Crohn's disease ulcer.A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn's disease.

Affiliation:
Division of Gastroenterology, University of Alberta, Edmonton, Alberta.

ABSTRACTCrohn's disease is a chronic inflammatory disease that can affect any part of the gastrointestinal tract. Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea. This case report describes a 38-year-old woman with Crohn's disease who presented with odynophagia. Direct visualization of the oropharynx revealed a large serpiginous Crohn's disease ulcer. A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn's disease. This manuscript describes the presentation of oropharyngeal Crohn's and reviews previous reports and management options.